Efficacy of phacoemulsification combined with goniosynechialysis for primary angle closure glaucoma
I. Ia. Novytskyy, R. M. Lopadchak, M. I. Novytskyy
Danylo Halytsky Lviv National Medical University, Ophthalmology Department;
City Clinical Hospital No.8;
TO CITE THIS ARTICLE: Novytskyy IIa, Lopadchak RM, Novytskyy MI. Efficacy of phacoemulsification combined with goniosynechialysis for primary angle closure glaucoma. J.ophthalmol.(Ukraine).2020;5:3-7. http://doi.org/10.31288/oftalmolzh2020537
Background: To date, no universal surgical strategy exists for primary angle closure glaucoma (PACG).
Purpose: To assess the clinical efficacy and hypotensive effect of phacoemulsification (phaco) combined with goniosynechialysis (GSL) for the treatment of PACG.
Material and Methods: Nine patients (9 eyes; mean age, 63.4 ± 9.6 years) with chronic angle-closure glaucoma who were under our observation were included in this study. Of these, 8 (8 eyes) underwent phaco-GSL, and one (1 eye) underwent GSL at some time after phaco. Failure to control IOP (the IOP higher than 22 mmHg on maximal tolerable hypotensive therapy) and synechial closure of the anterior chamber angle was the indication for surgery.
Results: Using the Mori goniolens was helpful in performing GSL in all anterior chamber quadrants. The IOP was 26.33 ± 3.6 mmHg before surgery, 18.44 ± 0.88 mmHg on day 7, 18.44 ± 1.13 mmHg on day 30, and 18.11 ± 1.5 mmHg on day 90. Visual acuity improved from 0.09 ± 0.05 to 0.35 ± 0.2. Mean number of hypotensive medications decreased from 2.8 ± 0.92 pre-surgery to 0.77 ± 0.83 post-surgery.
Conclusion: Phacoemulsification in combination with GSL has a good hypotensive effect. Intraoperative visualization of the anterior chamber angle and transection of synechia in all quadrants allows improving the efficacy of GSL procedure.
Keywords: phacoemulsification, primary angle closure glaucoma, goniosynechialysis, IOP
1.Tian T, Li M, Pan Y, Cai Y, Fang Y. The effect of phacoemulsification plus goniosynechialysis in acute and chronic angle closure patients with extensive goniosynechiae. BMC Ophthalmol. 2019 Mar 4;19(1):65. d
2.Alaghband P, Rodrigues IA, Goyal S. Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma. J Curr Glaucoma Pract. 2018. Jan-Apr 2018;12(1):45-9.
3.Shrivastava A, Singh K. The effect of cataract extraction on intraocular pressure. Curr Opin Ophthalmol. 2014 Mar;25(2):122-6.
4.Liu Y, Li W, Jiu X, Lei X, Liu L, Yan C, Li X. Systematic Review and Meta-Analysis of Comparing Phacoemulsification Combined with goniosynechialysis to other mainstream procedures in treating patients with angle-closure glaucoma. Medicine (Baltimore). 2019 Oct;98(42):e17654.
5.Zhang H, Tang G, Liu J. Effects of phacoemulsification combined with goniosynechialysis on primary angle-closure glaucoma. J Glaucoma. 2016 May;25(5):e499-503.
6.Lai JS, Tham CC, Chua JK. Efficacy and safety of inferior 180 degrees goniosynechialysis followed by diode laser peripheral iridoplasty in the treatment of chronic angle-closure glaucoma. J Glaucoma. 2000 Oct;9(5):388-91.
7.Lai JS, Tham CC, Lam DS. The efficacy and safety of combined phacoemulsifica-tion, intraocular lens implantation, and limited goniosynechialysis, followed by di-ode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma. J Glaucoma. 2001 Aug;10(4):309-15.
8.Harasymowycz PJ, Papamatheakis DG, Ahmed I, Assalian A, Lesk M, Al-Zafiri Y, et al. Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure. J Glaucoma. 2005 Jun;14(3):186-9.
9.Takanori K, Toshihiro I, Masaru I. Long-term efficacy of goniosynechialysis com-bined with phacoemulsification for primary angle closure. Graefes Arch Clin Exp Ophthalmol. 2013 Mar;251(3):825-30. Epub 2012 Jun 29.
10.European Glaucoma Society (EGS). Terminology and Guidelines for Glaucoma. 4th Edition. Nice, France: European Glaucoma Society (EGS), 2014. p.100-129.
11.Shwartz GF, Qulgley HA. Adherence and persistence with glaucoma therapy. Surv Ophthalmol. 2008 Nov;53 Suppl1:S57-68.
12.Tang Y, Tan J, Zhou X, Li X. Modified phacoemulsification plus goniosynechialysis compared with conventional surgery for cataract and glaucoma. Exp Ther Med. 2020 Jan; 19(1): 131–6.
The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.